Vietnam’s Challenging Healthcare System

By:
City Pass Guide

As Vietnam continues to rapidly evolve, the country will need to do its fair share of systematic restructuring to meet higher demands. This includes reshaping its $12 billion healthcare industry to meet international standards. This is not an easy task.

The Current State of Healthcare

Everyone probably agrees that Vietnam could use a bit of advice in regards to its healthcare management. With nearly 30 years of experience working as a doctor in Vietnam, Dr. Rafi from Family Medical Practice is in a good position to offer many informed suggestions on how to produce better results in the field of healthcare.

Photo via Pixabay

First, it is important to know that there are two kinds of healthcare systems running concurrently in Vietnam: one is the government ran hospitals, and the other is the foreign dominated private sector. The private sector is made up of small independent clinics. Understanding the difference between these two healthcare options is key in understanding how we can all work together to create a more efficient system for everyone.

The simplest suggestion that could be made in regards to hospital improvement is to focus on a thorough reorganisation of its current system. One of the most significant problems is the lack of modern equipment. Locally produced technology is implemented in many hospitals. Unfortunately, this is not sufficient to provide quality service to patients as it doesn’t meet international standards. Additionally, local doctors often rely too much on the equipment that they have as a crutch rather than a tool, and this can often result in poor treatment. Issues like overcrowding, poorly trained doctors, a lack of proper pharmaceuticals, and an overall disinterest in systemic modification have left many people wondering just what exactly is going on here.

On this ward, we have three doctors and ten nurses for 1,200 hemophilia patients. And, we have to take care of all other blood disorders that come in for treatment... it is better than three years ago.” - Nurse at Vietnamese hospital

Creating Clinic-style Services

Photo via Pixabay

Overcrowding is another issue to be addressed, as anyone who has ever entered a local hospital can immediately notice. What are some ways that Vietnam can restructure their system in order to facilitate less traffic in hospitals? One idea presented by Dr. Rafi is to create small clinical establishments as an alternative to hospitals. Often, locals from the countryside have to travel to major cities in order to get proper medical treatment. The current structure for medical care is too centralised in cities, leaving those residing outside of major centres in need of better treatment in close proximity to their homes. Perhaps if there was more of an interest and motivation to privatise the rural hospitals, there would be a significant increase in patient care. One important thing to mention here is that this kind of restructuring would not cost much money at all. Instead, it would require time spent planning, rethinking and reorganising, while cooperating with private sectors and medical authorities.

Enhancing the Private Sector

The private sector is clearly on the rise as more privately ran hospitals are opening in HCMC, as well as other major cities. This has occurred as a result of the underdeveloped options available, which have sparked a desire in private interests to help create more efficient treatment facilities. The government allows foreigners to practice in Vietnam, but they are limited to primary care and are usually (given a few exceptions) not allowed to operate or own their own hospitals. There is clearly a hesitance to allow foreign doctors and hospital managers to enter the “healthcare bubble”. As a result, you have two different systems (private sector and government ran) operating parallel to each other, when in reality they should be working together to create a better model. Perhaps building a better network and creating more cooperation between the two sectors would be the more practical way, especially considering that the private sector has seen growth in the past several years.

A report also showed that there are more than 30,000 private polyclinics, 87 small-sized maternity hospitals, 30 foreign-invested clinics, and 29 clinics with involvement of foreign doctors across the country.” (ngocentre.org)

Doctor Quality

Another important issue to discuss is the quality of doctors here in Vietnam. It seems that most people, both foreign and local, don’t often trust your average run-of-the-mill physician, and for good reason. The Vietnamese population spends over $4 billion a year seeking medical treatment in places like Bangkok and Singapore due to the limited amount of qualified and skilled practitioners available here. They don’t trust the services provided at the hospitals, corrupt doctors and therefore decide to have medical attention attended to abroad.

Photo via Pixabay

Another reason for this is that unlike Thailand, whose doctors are trained overseas and then return to practice in their home country, the best Vietnamese doctors leave for international quality training and do not return to Vietnam. This is because the salary is low, the working conditions are not ideal, and there is not really any benefit for them to utilise their skills here. In many other countries doctors often enjoy a handsome salary, high social status and strong government support. However, this is often not the case in Vietnam. This pushes the well-trained doctors away and enables “grey medicine” to occur. We’ve all heard the stories about how some doctors choose to compensate for their low salary, and these are often shocking to hear.

“The Vietnamese population spends over $4 billion a year seeking medical treatment in places like Bangkok and Singapore due to the limited amount of qualified and skilled practitioners available here.”

On a rather more positive note, it is worth mentioning how the prevalence of English is having a direct correlation on the education of doctors. Considering the fact that learning English is inarguably a high priority in Vietnam, the results are clearly carried over to one’s inherent ability to self-educate. Doctors now have the ability to comprehend international medical publications, research data and other valuable information that was inaccessible before. Doctors that are driven and have a thirst for knowledge can readily use the internet as a tool to learn more about medicine and apply it to their daily practice.

What’s Next?

While the country progresses economically, people are becoming more educated and aware that there are serious problems facing healthcare. As locals also become more exposed to higher quality services offered in other countries, we can be sure that the demand for changes to be implemented will be on the rise. The question is, how will such public outcry be handled and will there be attempts to refine the system on a national scale? If not, Vietnam will continue to put its money into the pockets of other doctors abroad, and the less fortunate will bear the burden of such a system.

How Can We Help Fight The Covid-19 Coronavirus Pandemic?

By:
Leroy Nguyen

A heartfelt message from Pham Chau Linh, co-founder of the Together Against COVID-19 initiative ...

My husband and I wanted to do something to help Can Gio Quarantine Center, where my husband recently went under quarantine. We began a charitable initiative which we wish to expand to cover all COVID-19 treatment and quarantine centers in and around Ho Chi Minh city. We have found that many of our friends want to join forces with us, both Vietnamese locals and expats currently residing in Vietnam, but many don’t know HOW to help.

Image source: vietnamnews.vn

I put together this simple document in the hopes that all of you can refer to it as a clear guide to give you some ideas of how you can contribute to the global cause. Hopefully together we can help fight against the COVID-19 pandemic.

This initiative is carried out with consultation and immense support from Dr. Nguyen Tran Nam, for which we would like to express our deepest gratitude!

Core purpose

To donate much needed medical supplies in the fastest and most effective manner so that these items can be put to use immediately within medical and quarantine centers. Our focus is on providing protective equipment / tools / items to medical staff who are at the highest risk level, medical staff that are working directly with COVID-19 patients.

What are we currently doing?

We are currently focusing on providing protective workwear and eye-protection, with a mission to expand and include other medical supplies at a later point. The key to prioritising what to buy depends on 3 factors:

1. What exactly is short of supply?

2. Validated quality of products that are certified safe to be used at medical and quarantine centers (not everything does, unfortunately).

3. Low cost – the lowest cost possible is always sought after.

Image source: customsnews.vn

Who do we currently distribute to?

- Can Gio COVID-19 hospital & quarantine center.

- The U.S. Centers for Disease Control and Prevention (HCMC CDC) who will then distribute goods out to centers in need, according to priority.

As the initiative grows, we wish to reach even further than our current reach. Join a great cause and help to support the community on this critical and urgent mission.

What have we achieved so far?

- We have raised over VND 322 million.

- Over 500 sets of protective workwear and 500 pieces of eye protection have been donated to Can Gio Medical & Quarantine center.

- Over 500 sets of protective workwear and 200 medical masks have been donated to HCMC CDC headquarters in HCMC.

Image source: english.net

For more information regarding the initiative and how you can volunteer and/or contribute, please do not hesitate to contact me!Pham Chau Linh Phone: 0903946193 (phone, whatsapp, zalo, viber, messenger) Email: phamchaulinh@gmail.com

The COVID-19 coronavirus, officially termed a global pandemic, has literally spun the world into lockdown. It is so important to play our part and STAY HOME. Protect ourselves, protect our family and friends, and protect our beautiful community.

“If I test positive for COVID-19 coronavirus, does my current health insurance policy cover all costs?”

Below we’ve listed some health insurance options currently available to foreigners residing in Vietnam, in particular, policies that cover COVID-19 coronavirus treatments. If you’re aware of any other health insurance services that cover COVID-19 please do let us know so that we may update this list and continue to keep our community well informed.

STAY HOME. STAY SAFE. STAY HEALTHY.

SAIGON HANOI BANK (SHB) - NcoV Shield

- Eligible to all Vietnamese and foreign residents living, studying, working in Vietnam.

- No age restrictions.

- Payment for inpatient treatment of viral pneumonia of the Corona strain.

PRUDENTIAL VIETNAM

- PLEASE NOTE: This policy is applicable ONLY to existing Prudential Vietnam health insurance policy holders. The program applies to individual customers who are the Policyholder and the Insured of both main and supplementary products of the Insurance Contract issued by Prudential and valid for the duration of the program.

- This is a special program for unfortunate customers who are infected with the 2019-nCoV virus from February 6, 2020 to April 30, 2020.

- The program offers cash assistance that corresponds to the severity level based on the number of days a client is on hospital isolation.

- With the duration of isolation / hospitalization for 3 to 9 days, the support value is VND 10 million / customer.

- With the duration of isolation / hospitalization for 10 days or more, the value of the support cash assistance of VND 20 million / customer.

A young Vietnamese woman is pulled in two directions: on the one side, she’s just received a big promotion at work, and she’s excited about where her career is taking her; on the other, her family constantly reminds her that she has to think seriously about getting married and settling down.

The choice is ultimately up to her, but it often leads to anxiety and depression.

It’s these sorts of scenarios, involving the battle between traditional values and modern opportunities, that lead people to seek Psychotherapist Azrael Jeffrey’s services at the International Center for Cognitive Development (ICCD). “It’s about supporting them in their endeavors, and with what would make them happy, whether it be quitting their job or moving to another country,” he says.

At the moment Jeffrey and his team at ICCD are among the few fully accredited mental health practitioners in Ho Chi Minh City—but that doesn’t mean there’s not a need for them.

Vietnam’s National Institute of Mental Health (NIMH) stated in 2016 that 30 percent of Vietnam’s population suffer from some form of mental illness, primarily depression (25 percent).

According to the Vietnam Veterans of America Foundation (VVAF), the rate of diagnosable mental disorders in Vietnam is 15 percent, a noticeable difference.

These wide variants point to a larger problem: an incomplete portrait of mental health issues in Vietnam.

A Shadowed History

Mental health in Vietnam has been compartmentalised. Jacqueline Langton, a psychologist with a private practice in HCMC, notes that, “Degrees and specialisation for doctors in psychiatry have been well supported here in Vietnam. In contrast, psychology is still in its infancy.”

Psychiatry was practised mainly in the form of government-run mental hospitals, which took in patients suffering from severe mental illnesses like schizophrenia and delusional disorders (60 percent of patients, according to Ministry of Health statistics), mood disorders (15 percent) and stress-related disorders (15 percent).

Image source: agarwood.org.vn

Alternatively, the Western concept of help being sought during stressful times or dark life moments was completely foreign.

A stigma began to form against seeking help, although Langton notes that this is an issue in her native Australia as well.

“In Vietnam I see stigmas shifting between generations; in Vietnam a student may openly talk about experiencing depression but struggle with discussing it with their parents, or their parents may struggle sharing that information outside of their immediate relatives,” she says.

A Matter of Perception

This purveying stigma has led many to believe that psychology couldn’t be integrated into Vietnamese society as it is in North America and Europe.

When Azrael Jeffrey founded ICCD two years ago, he noticed that it wasn’t the Vietnamese who had a problem with it—it was the foreigners: “Most people thought it was silly. There was the stereotype that Vietnamese people don’t like psychology. It’s not true. They’re curious about it.”

Image source: cigna-healthcare.com

Both Jeffrey and Langton noted that the problem of practising psychology in HCMC wasn’t that it was frowned upon, but rather that there was no system of reference for it, leading to difficulties when it came to paperwork.

Jeffrey, for example, remembers hiring a speech pathologist—the first in the country. “Getting a work permit was hard. There was no “speech pathologist” career they could enter. It didn’t exist in Vietnam yet.”

Molding Young Minds

Right now the vast majority of formally registered psychologists in Vietnam are expatriates, but this is likely to change in the coming years.

Apart from individual sessions, Azrael Jeffrey also counsels college students, and he’s seeing more and more interest in the field of psychology.

Image source: backend.bazaarvietnam.vn

Rather than study in Vietnam, where counselling programs are still quite limited, Jeffrey encourages interested students to pursue their education overseas.

“When they come back in five or six years, Vietnamese psychologists will probably take the forefront here,” he predicts.

For now, it’s all about changing cultural perceptions, and this might be easier than previously supposed.

Jacqueline Langton has noticed a definite shift in the perception of psychology in her seven years in Vietnam, as has Jeffrey.

“I’ve seen tremendous change,” he says.

“When I first came here and said I was a psychologist, it would clear the room. Now I say it and people come up to me and start asking questions.”

Looking at the menu, densely packed with highly caloric, over-sized portions (which we have become accustomed to in our modern world) we succumb and gorge. Busy lifestyles and poor choices while eating out often lead to further weight gain. Let’s have a look at how we can better deal with this and make better choices at the restaurant.

Societal Pressure

Socio-economics definitely influence our food choices both in selecting a restaurant/cafe and what we decide to order. We like to “fit in,” and eat what our friends munch on.

We’ve all heard too often from friends and family, “Oh come on, just eat it! You only live once, it won’t kill you…” Seemingly when you choose to eat healthy, you may become the outcast among your friends. This compounds matters as striving for acceptance is human nature.

Why all the talk of sociological factors when we just want healthy eating tips? Because the challenge is largely psychological and habitual. Most of it is really common sense but unfortunately eating substandard food has simply become socially accepted.

Right then, let’s get into making some better nutritional choices.

Photo by Pixabay

Local Food Suggestions

Vietnamese grilled fish and meats are ideal dishes, as well as soups and hot pots. Many Japanese and Korean restaurants around Saigon have solid, healthy choices in contrast to the majority of most Western menus offered throughout the city.

Next time you enjoy your favourite pho or bun bo, ask for less noodles in order to maximise your healthy diet. In regards to MSG, well, you know what it is, and we must accept that it’s nearly unavoidable when eating out in HCMC. Goi cuon (chicken spring roll), goi xoai (mango salad) and ca nuong la chuoi (grilled fish with banana leaf) are a few healthy Vietnamese options.

Photo by Pixabay

Indian food doesn’t have to be heavy. Go for the tandoor chicken breast or lamb as long as you make sure to request it with no butter or cream. Choosing brown rice over naan is also another way to manoeuvre around the fattening dishes lingering at your table. When eating Italian, skip the primi and go straight for secondi.

Sugar and excess carbs are fundamentally problematic. Lower these and increase the veggies and proteins. For all the lovely vegetarians, choose protein rich beans and legumes. This is a challenge in Vietnam as most vegetarian restaurants do not include beans on the menu. Sure tofu is good, but this protein packed veggie has a long history of nutritional controversy.

Portion size is paramount. Share a pizza instead of having a whole one, as so many of us are carb junkies consuming these saccharides voraciously, reducing portions is the goal.

How Unhealthy is Alcohol?

Alcohol! The ultimate socially accepted evil. What? Nothing wrong with a few glasses of wine paired with your meal you say? Well, not exactly. Regarding weight gain, alcohol is more than a double whammy. This potion is broken down into acetate, which your body will use first for energy before anything else you eat or drink. Alcohol is metabolised, fat oxidation stops, weight gain may occur and slowed metabolism may result.

Photo by Stephen Bentsen

An average glass of wine has 150 calories, and beer has about the same. People who drink alcohol with a meal often eat up to 30% more food, and considering the culture of pairing food and drink in HCMC, this may cause a problem for many.

Juices and Sodas

Fruit juices are commonly thought to be a healthier choice over soda. Studies show that the effects on our bodies are virtually the same. According to a recent publication in the Nutrition journal, fruit juice has a fructose concentration of about 45.5 grams per litre, slightly less than the average of 50 grams per litre for sodas.

"The human body isn't designed to process [fructose] at such high levels. Fructose is processed almost entirely in the liver where it is converted to fat, which increases risk for diabetes, cardiovascular disease and liver disease,” says Michael Goran, Director of Childhood Obesity Center in Southern California.

Essentially sodas and fruit juices should be avoided altogether. Eat fresh fruit instead, which includes fibre, slowing down absorption of sugars and allowing the normal metabolism of fructose. As an alternative, drink lots of local fruit smoothies (like avocado) but without condensed milk or sugar. Try an avocado smoothie for healthy fats.

“The only way to keep your health is to eat what you don’t want, drink what you don’t like, and do what you’d rather not.” - Mark Twain

A Brighter Smile in Saigon

By:
Patrick Gaveau

We sat down with Dr. Philippe and Chau Guettier, two well-known dentists who have run the Starlight Dental Clinic for over 20 years, in order to find out more about dental care in HCMC and Vietnam.

In your opinion, is the Vietnam dental industry currently developed in HCMC?

Philippe: During the last 15 years it has developed a lot. Especially in terms of quality, it has improved much in the past three to four years. At the university level, the education of the dentists is getting better and better. There is much more training done by foreign universities - namely French universities. Now young dentists who graduate receive much better education for their practice.

Is developing the dental industry and pushing dental care a concern for the Ministry of Health?

Philippe: The Ministry has a good control over the quality of the clinic. In France, once you graduate and open your clinic, you will never get any check-ins from the government on a yearly basis to see if everything is taken care of. In Vietnam, each clinic gets a check-in from the Ministry of Health every year. This is good for maintaining the quality of clinics here.

In terms of equipment, are there concerns or issues based on the different levels of clinics? Or is there a general standard?

Philippe: Basically, what the government will control are x-rays, sterilisation, and product lifespan. After, they will not check if the tools or the products you are using to treat the patient are good quality or not. Unfortunately in Vietnam you have many products made in China - machines, or products you put into the patient's mouth. The instruments used to treat and restore a patient’s teeth will not be of the same quality. There is quite a big discrepancy from one clinic to another.

Do the majority of locals value the importance of having healthy teeth?

Philippe: You have a growing middle class. Once you go outside Ho Chi Minh City or Hanoi, there’s still a big gap. You have to look at the ratio of how many dentists there are for the population. In France, it’s 1 dentist for 1,500 people. In Vietnam, it’s 1 dentist for nearly 10,000 people.

We’ve seen more obesity in children in Vietnam in the past 10 years. Is this also affecting dental care?

Chau: I think the main reason for cavities is how you brush and take care of your teeth. Even if they eat a lot, if they brush their teeth afterwards they will not have problems. Now, people have more education on how to keep their teeth clean.

Philippe: We go to a lot of schools and have a program for this. We teach the children what are cavities, how to brush your teeth, and we give them a toothbrush. But to answer your question, I think we have more cavities than before for the kids. The quality of food (with fast food and soft drinks) has decreased. Even if you have kids in international schools with wealthy families, you’d still be surprised by the number of cavities that can be found.

Will there be an expanding future market for orthodontics?

Philippe: By definition, everybody knows Vietnam is a young country [laughs] with a lot of kids, so sure there is a market for orthodontics. Now, you have parents who want their children to have great teeth for the future, so they bring them in for orthodontics. But you also have a lot of young Vietnamese adults who get orthodontics, because as kids they didn’t have this. As opposed to France, where mostly children get orthodontics, in Vietnam we have many more adults patients.

If you had to give a price difference between the majority of treatments, how much less expensive would it be here than Australia, including the cost of travel and board?

Philippe: Australia would be three to four times as expensive, at least.

Chau: But it depends on the treatment. To give an example, I had a quotation from a patient in Australia for one impacted wisdom tooth removal for $1,200. At our clinic in HCMC the cost is $120.